How to maximise vaccination uptake

As of 1 April 2016 the item of service fee for immunisation rose to £9.80. Vaccinations represent a significant amount of practice income, so how can practices maximise the number of patients immunised with the least amount of fuss?

It is hard to catch up on childhood vaccinations if the practice falls behind on recall (Picture: SPL)

The vaccination schedule of general practice has grown in the past few years. The list of vaccinations covered under the GMS contract and directed enhanced services is set out in the table below.

3 months old: DTaP/IPV/Hib, Men C (from 1 July this vaccine is removed) and rotavirus

4 months old: DTaP/IPV/Hib, Men B and PCV

12-13 months old: HIb/Men C, Men B, PCV and MMR

Children under 5

3 years and 4 months old: DTaP/IPV and MMR

Shingles

Patients aged 70. Patients remain eligbile until their 80th birthday.

Can have the vaccine at any point during the year

Shingles catch-up

Patients aged 78 year on 1 September 2016.

Can have the vaccine at any point during the year

Influenza

Under 65 and at risk (see QOF or DH letter for who is defined as 'at risk')

Over 65s

From September to March

Childhood influenza

Children aged two, three or four on 31 August 2016.

From September to March but vaccine has short shelf life so ensure you check expiry dates

Pneumococcal

Over 65s

From September to March

Hep B for newborns

Newborn babies born to mothers who are Hep B positive

First dose: at first opportunity (usually in hospital)

Second dose: age 1month or as soon as possible

Third dose: age 2 months or as soon as possible

Fourth dose: 12 months or as soon as possible and deliver or refer for a heel prick blood test

MMR for over 16s

Over 16s who have not had MMR vaccine

Opportunistic vaccination of eligible patients (the Green Book recommends that those born before 1970 do not require vaccination). One or two doses as required.

Pertussis

Pregnant women who reach (or were already at) the 20th week of pregnancy from April 1 2016 to March 2017 unless contra-indicated

Vaccination of pregnant women and new mothers who missed the opportunity to be vaccinated while pregnant.

MenACWY for freshers

19-25 years attending university/further education for first time who have not been previously vaccinated

Opportunistic vaccination of eligible patients

HPV booster

For girls aged 14 to 18

This is programme is to ensure eligible girls who missed the vaccination at school are still protected. Practices are not required to idenitfy or call and recall eligible patients.

MenACWY booster

Aged 14-25

Not had a previous MenC vaccine since aged 10 or missed the opportunity to be vaccinated during the school programme.

Opportunistic vaccination of eligible patients

Easy tips for maximising the numbers immunised

1. Have a clinical and non-clinical lead for childhood immunisations. Childhood immunisations are a large chunk of income and it is very difficult to catch up if you fall behind on recall.

Ensure that rotavirus is included as part of childhood immunisations programme and make sure that you have a robust recall system for monitoring your childhood vaccinations.

An admin person can telephone all who haven’t had the vaccine and offer a telephone consultation with a nurse to go through queries if there are fears about the vaccinations.

It might also be useful to get a native speaker to make the calls if your area has many whose first language is not English and for whom the vaccination schedule is different to the one they are used to.

2. Plan your winter flu campaign. Put aside time to plan clinics and make sure you have enough vaccine, staff and resources to manage the flu clinics.

Advertise that you are running the clinics to patients using the phone system and the right hand side of prescriptions. Ask reception to offer clinic appointment to all eligible patients.

3. Use one patient visit to give multiple vaccines. To tick as many vaccination boxes as possible, the over 65s should be offered both flu and pneumoccocal if feasible, this saves double trips and will increase your uptake of pneumoccocal vaccines.

Alternatively, consider running pneumoccocal clinics throughout the year and offering the shingles jab to any patient who is either 70 or 79 in the same clinics.

4. Make all clinicians aware of the vaccination cohorts. You could use the above table to do this. Ask all clinicians to offer vaccinations to relevant groups opportunistically. Remind staff periodically to ensure that they offer the vaccine. Reception could also be briefed to offer appointments for specific vaccines to any eligible patient.

5. Ask nurses doing travel clinics to check patients' MMR status and Men C status when they attend for travel vaccinations - and adminster these jabs when possible.

Fionnuala O'Donnell is a practice manager in Ealing, West London, and a CCG board member

If you have any other tips on boosting vaccine uptake that you feel practices could benefit from, please comment below to share them.